Revista brasileira de anestesiologia最新文献

{"title":"Anestesiologia pediátrica e o paradoxo da COVID‐19: opinião do Comitê de Anestesia em Pediatria da Sociedade Brasileira de Anestesiologia","authors":"Mariana Fontes Lima Neville , Pedro Paulo Vanzillotta , Vinícius Caldeira Quintão","doi":"10.1016/j.bjan.2020.04.003","DOIUrl":"https://doi.org/10.1016/j.bjan.2020.04.003","url":null,"abstract":"","PeriodicalId":21261,"journal":{"name":"Revista brasileira de anestesiologia","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.bjan.2020.04.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"92104046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anestesia espinhal em pacientes com COVID‐19, mais pesquisa é necessária","authors":"Masoud Hashemi , Mehrdad Taheri , Reza Aminnejad","doi":"10.1016/j.bjan.2020.04.002","DOIUrl":"https://doi.org/10.1016/j.bjan.2020.04.002","url":null,"abstract":"","PeriodicalId":21261,"journal":{"name":"Revista brasileira de anestesiologia","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.bjan.2020.04.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"92104048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Avaliação de testes à beira leito e proposta de modelo para prever laringoscopia difícil: estudo prospectivo observacional","authors":"Chara Liaskou ,&nbsp;Eleftherios Vouzounerakis ,&nbsp;Anastasia Trikoupi ,&nbsp;Chryssoula Staikou","doi":"10.1016/j.bjan.2020.02.007","DOIUrl":"https://doi.org/10.1016/j.bjan.2020.02.007","url":null,"abstract":"<div><h3>Background and objectives</h3><p>The prediction of difficult laryngoscopy is based on tests that assess anatomic characteristics of face and neck. We aimed to identify the most accurate tests and propose a multivariate predictive model<strong>.</strong></p></div><div><h3>Methods</h3><p>This prospective observational study included 1134 patients. Thyromental Distance (TMD), Sternomental Distance (STMD), Ratio of Height‐to‐Thyromental Distance (R‐H/TMD), Neck Circumference (NC), Ratio of Neck Circumference‐to‐Thyromental Distance (R‐NC/TMD), Hyomental Distance with head in Neutral Position (HMD‐NP) and at Maximal Extension (HMD‐HE), Ratio of Hyomental Distance at Maximal head extension‐to‐hyomental distance in neutral position (R‐HMD), Mallampati Class (MLC), Upper Lip Bite Test (ULBT), Mouth Opening (MO) and Head Extension (HE) were assessed preoperatively<strong>.</strong> A Cormack‐Lehane Grade ≥ 3 was defined as Difficult Laryngoscopy. Sensitivity, specificity, positive and negative predictive values were assessed for all tests. Multivariate analysis with logistic regression was used to create the predictive models.</p></div><div><h3>Results</h3><p>A model incorporating MLC, ULBT, HE, HMD‐HE and R‐NC/TMD showed high prognostic accuracy; x²(5)<!--> <!-->=<!--> <!-->109.12, <em>p</em> &lt;<!--> <!-->0.001, AUC<!--> <!-->=<!--> <!-->0.86, <em>p</em> &lt;<!--> <!-->0.001). Its sensitivity, specificity and negative predictive value were 82.3%, 74.8% and 97.4%, respectively. A second model including two measurements not requiring patient's cooperation (R‐NC/TMD and HMD‐HE) exhibited good prognostic performance; x²(2)<!--> <!-->=<!--> <!-->63.5, <em>p</em> &lt;<!--> <!-->0.001, AUC<!--> <!-->=<!--> <!-->0.77, <em>p</em> &lt;<!--> <!-->0.001. Among single tests, HE had the highest sensitivity (78.5%) and negative predictive value (96%).</p></div><div><h3>Conclusions</h3><p>A five‐variable model incorporating MLC, ULBT, HE, HMD‐HE and R‐NC/TMD showed satisfyingly high predictive value for difficult laryngoscopy. A model including R‐NC/TMD and HMD‐HE could be useful in incapable patients. The most accurate single predictor was HE.</p></div>","PeriodicalId":21261,"journal":{"name":"Revista brasileira de anestesiologia","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.bjan.2020.02.007","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"92104049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparação de videolaringoscópio com canal e máscara laríngea na intubação traqueal de pacientes obesos: estudo clínico randomizado","authors":"Canan Kamile Turna,&nbsp;Zehra Ipek Arslan,&nbsp;Volkan Alparslan,&nbsp;Kamil Okyay,&nbsp;Mine Solak","doi":"10.1016/j.bjan.2020.01.008","DOIUrl":"https://doi.org/10.1016/j.bjan.2020.01.008","url":null,"abstract":"<div><h3>Background</h3><p>Obesity causes various difficulties in intubation and ventilation, which are confronted due to increased fat tissue in the upper airway and diminished compliance in the chest wall. Videolaryngoscopes and Intubating Laryngeal Mask Airway (ILMA) are good options as recommended by the American Society of Anesthesologists (ASA) difficult airway guidelines. We aimed to compare ILMA and Airtraq (a channeled videolaryngoscope) in obese patients.</p></div><div><h3>Methods</h3><p>Eighty patients with ASA physical status I‐III, aged between 18 and 65 years and with a body mass index greater than 35 kg.m^‐2, who were undergoing elective surgery requiring orotracheal intubation, were included in the study. Patients were intubated with one of the devices cited.</p></div><div><h3>Results</h3><p>There was no difference between the number of intubation attempts, insertion times and need for optimisation manoeuvres of Airtraq and ILMA. The intubation with Airtraq was accomplished in a shorter period of time than in that in the ILMA group (29.9<!--> <!-->±<!--> <!-->22.1<!--> <!-->s vs. 50.7<!--> <!-->±<!--> <!-->21.2<!--> <!-->s; <em>p</em> <!-->&lt;<!--> <!-->0.001). A significant difference was found when the times of total intubation were compared (29.9<!--> <!-->±<!--> <!-->22.1<!--> <!-->s vs. 97.4<!--> <!-->±<!--> <!-->42.7<!--> <!-->s; <em>p</em> <!-->&lt;<!--> <!-->0.001). The mean arterial pressure statistically increased after device insertion in the ILMA group (<em>p</em> <!-->&lt;<!--> <!-->0.05).</p></div><div><h3>Conclusions</h3><p>Airtraq appears to be superior to ILMA in obese patients, with a total of time intubation of less than 60 seconds and with low mean arterial pressure changes. However, ILMA is still a useful tool that provides both ventilation and intubation throughout the whole intubation process.</p></div>","PeriodicalId":21261,"journal":{"name":"Revista brasileira de anestesiologia","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.bjan.2020.01.008","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"92104051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"O Anestesiologista e a COVID‐19","authors":"Vinícius Caldeira Quintão ,&nbsp;Cláudia Marquez Simões ,&nbsp;Laís Helena Navarro e Lima ,&nbsp;Guilherme Antônio Moreira de Barros ,&nbsp;Marcello Fonseca Salgado‐Filho ,&nbsp;Gabriel Magalhães Nunes Guimarães ,&nbsp;Rodrigo Leal Alves ,&nbsp;Ana Maria Menezes Caetano ,&nbsp;André Prato Schmidt ,&nbsp;Maria José Carvalho Carmona","doi":"10.1016/j.bjan.2020.03.002","DOIUrl":"https://doi.org/10.1016/j.bjan.2020.03.002","url":null,"abstract":"","PeriodicalId":21261,"journal":{"name":"Revista brasileira de anestesiologia","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.bjan.2020.03.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"92068533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impacto da analgesia pós‐toracotomia com dexmedetomidina e morfina em imunócitos: estudo randomizado","authors":"Pengfei Lei ,&nbsp;Jin Wang ,&nbsp;Shan Gao ,&nbsp;Bo Du ,&nbsp;Hao Wang ,&nbsp;Weichun Li ,&nbsp;Fei Shi ,&nbsp;Aijun Shan","doi":"10.1016/j.bjan.2019.12.017","DOIUrl":"https://doi.org/10.1016/j.bjan.2019.12.017","url":null,"abstract":"<div><h3>Objective</h3><p>This study aimed to investigate the impact of post‐thoracotomy analgesia with dexmedetomidine and morphine on immunocytes.</p></div><div><h3>Methods</h3><p>A total of 118 patients with post‐thoracotomy Patient‐Controlled Intravenous Analgesia (PCIA) in our hospital from March 2016 to July 2018 were randomly selected and divided into the Composite (COM) Group (57 patients administered with dexmedetomidine [1.0 μg.kg^‐1 body weight] and morphine [0.48 mg.kg^‐1 body weight]) and the Morphine (MOR) Group (61 patients administered with morphine [0.48 mg.kg^‐1]). The values of lymphocyte subsets (CD3+, CD4+, and CD8+) and Natural Killer cells in the peripheral blood of these two groups were detected by FACSCalibur flow cytometry at different time points (before anesthesia induction [T0], immediately after tracheal extubation [T1], 12 hours after surgery [T2], 24 hours after surgery [T3], 48 hours after surgery [T4], 72 hours after surgery [T5], and 7 days after surgery [T6]). The doses of morphine at T3 to T5 and the adverse reactions between the two groups were also recorded and compared.</p></div><div><h3>Results</h3><p>The CD3+ level and the CD4+/CD8+ ratio at T2 to T5 and the CD4+ level and NK cells at T3 to T5 were significantly higher in the COM Group than in the MOR Group (<em>p</em> <em>&lt;</em> 0.05). The postoperative morphine dose and the incidence of postoperative itching, nausea, and vomiting were significantly lower in the COM Group than in the MOR Group (<em>p</em> <em>&lt;</em> 0.05).</p></div><div><h3>Conclusions</h3><p>Dexmedetomidine combined with morphine for post‐thoracotomy PCIA can improve the function of immunocytes, reduce morphine consumption, and reduce the adverse reactions during analgesia induction.</p></div>","PeriodicalId":21261,"journal":{"name":"Revista brasileira de anestesiologia","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.bjan.2019.12.017","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"92104054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anestesia geral associada a bloqueio do plano do músculo eretor da espinha para encerramento de persistência de canal arterial: dois relatos de caso","authors":"Erica Viviana Guimarães Carvalho,&nbsp;Joana Luísa Borges Marques,&nbsp;Maria João Falle Gomes dos Santos","doi":"10.1016/j.bjan.2020.01.001","DOIUrl":"https://doi.org/10.1016/j.bjan.2020.01.001","url":null,"abstract":"<div><h3>Background</h3><p>Failure of ductus arteriosus closure in preterm neonates results in a left‐to‐right shunt that leads to variable severities of hemodynamic and respiratory distress. When medical therapy fails, surgical ligation via left lateral thoracotomy remains an alternative approach and can be performed in the operating room or at the bedside with a low mortality rate. Opioid‐based anesthesia is a frequent choice among anesthesiologists who manage patent ductus arteriosus cases based on the suppression of the stress response and maintenance of hemodynamic stability. This rationale suggests that regional anesthesia may also be an advantageous technique and may benefit earlier weaning from ventilation. Blocking afferent signals before incision may also modulate the long‐term consequences of altered sensory perception and pain responses.</p></div><div><h3>Case report</h3><p>We present two cases of general anesthesia combined with erector spinae plane block as part of multimodal anesthesia in premature twins undergoing patent ductus arteriosus closure.</p></div><div><h3>Discussion</h3><p>In these cases, the use of erector spinae plane block combined with general anesthesia was efficient to minimize the negative impact of surgery and allowed a reduction in the amount of intraoperative opioid use for patent ductus arteriosus closure.</p></div>","PeriodicalId":21261,"journal":{"name":"Revista brasileira de anestesiologia","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.bjan.2020.01.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91992336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"O manejo do absorvedor de CO2 durante o uso do aparelho de anestesia como respirador mecânico em pacientes com COVID‐19","authors":"Marcelo Luis Abramides Torres,&nbsp;Fernando Augusto Tavares Canhisares,&nbsp;Vinícius Caldeira Quintão","doi":"10.1016/j.bjan.2020.04.001","DOIUrl":"https://doi.org/10.1016/j.bjan.2020.04.001","url":null,"abstract":"","PeriodicalId":21261,"journal":{"name":"Revista brasileira de anestesiologia","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.bjan.2020.04.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"92104047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nova cânula orofaríongea de duplo lúmen para sedação em ecocardiografia transesofágica: série de casos","authors":"Caetano Nigro Neto ,&nbsp;Francisco José Lucena Bezerra ,&nbsp;Rodrigo Bellio de Mattos Barreto ,&nbsp;Davi Costa de Souza Le Bihan ,&nbsp;Vinicius Tadeu Nogueira da Silva do Nascimento ,&nbsp;Ingrid Caroline Baia de Souza","doi":"10.1016/j.bjan.2020.03.005","DOIUrl":"https://doi.org/10.1016/j.bjan.2020.03.005","url":null,"abstract":"<div><h3>Introduction</h3><p>Currently, transesophageal echodopplercardiography (TEE) is frequently performed under sedation on an outpatient basis. Sedation is related with increase in incidents on airways. Bearing in mind this scenario, we developed a new double lumen oropharyngeal cannula aimed at keeping airway patency, in addition to reducing risks to patients during endoscopy procedures performed under sedation. The main objective of our study was to assess the incidence of oxygen desaturation in a series of cases of adult patients submitted to outpatient TEE exam, under sedation and using the oropharyngeal cannula.</p></div><div><h3>Method</h3><p>Thirty patients under sedation with intravenous midazolam and propofol were assessed. After loss of consciousness, the cannula was placed and patients were maintained on spontaneous breathing. Oxygen saturation, capnometry, heart rate and non‐invasive arterial blood pressure, in addition to subjective data: airway patency, handling of cannula insertion, and comfort of examiner were analyzed.</p></div><div><h3>Results</h3><p>The incidence of mild desaturation was 23.3%, and there was no severe desaturation in any of the cases. The insertion of the oropharyngeal cannula was considered easy for 29 patients (96.6%), and TEE probe handling was appropriate in 93.33% of exams performed.</p></div><div><h3>Conclusions</h3><p>TEE exams under sedation aided by the double‐lumen oropharyngeal cannula presented a low incidence of desaturation in patients assessed, and allowed analysis of expired CO₂ during the exams.</p></div>","PeriodicalId":21261,"journal":{"name":"Revista brasileira de anestesiologia","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.bjan.2020.03.005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"92104045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A população cirúrgica muito idosa em cuidados intensivos: características clínicas e desfechos","authors":"Diana de Jesus Neves Silva ,&nbsp;Luís Guilherme Galego Casimiro ,&nbsp;Mónica Isabel Sequeira de Oliveira ,&nbsp;Luciana Brás da Cunha Ferreira ,&nbsp;Fernando José Pereira Alves Abelha","doi":"10.1016/j.bjan.2019.10.001","DOIUrl":"https://doi.org/10.1016/j.bjan.2019.10.001","url":null,"abstract":"<div><h3>Background</h3><p>The elderly population is an especially heterogeneous group of patients with a rising number of surgical interventions being performed in the very elderly patient. The aim of this study was to evaluate the correlation between different age strata and functional status with the surgical outcome of the elderly patient.</p></div><div><h3>Methods</h3><p>Retrospective cohort study conducted in a Surgical Intensive Care Unit (SICU), between 2006 and 2013. A total of 2331 surgical patients ≥ 65 years old were included. Patients were grouped according to age: Older Elderly Group (OEG: 65‐85 years old); Very Elderly Group (VEG &gt; 85 years old). Demographic and perioperative data were recorded. Revised Cardiac Risk Index, APACHE II and SAPS II scores were calculated and postoperative complications were documented. Variables were compared on univariate analysis.</p></div><div><h3>Results</h3><p>The incidence of the VEG was 5.4%. This group had a higher proportion of non‐elective surgery (22.4% vs. 11.2%, <em>p</em> &lt; 0.001), higher APACHE II (12.0 vs. 10.0, <em>p</em> &lt; 0.001) and SAPS II (26.6 vs. 22.2, <em>p</em> &lt; 0.001) scores, higher incidence of organ failure (24.6% vs. 17.6%, <em>p</em> = 0.048) and a higher mortality rate during SICU (14.0% vs. 5.2%, <em>p</em> = 0.026) and hospital stay (9.3% vs. 5.0%, <em>p</em> = 0.012).</p></div><div><h3>Conclusion</h3><p>We found that very elderly patients represented a significant proportion of patients admitted to the SICU. They had higher severity scores with a higher prevalence of organ failure and were more likely to undergo non‐elective surgery. They had worse outcomes in regarding mortality during SICU and hospital stay.</p></div>","PeriodicalId":21261,"journal":{"name":"Revista brasileira de anestesiologia","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.bjan.2019.10.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"92051477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}